DEDICATED EDUCATIONAL

NURSING UNIT: CLINICAL INSTRUCTORS

ROLE PERCEPTIONS AND LEARNING NEEDS
DONNA M. GLYNN, PHD, APRN*,†, CECILIA MCVEY, MHA, BSN, RN‡,
JUDITH WENDT, MSN, RN§,║, AND BONNIE RUSSELL, MSN, RN¶,#

Over the past decade, health care leaders have called for a radical transformation in health care
and nursing education. Patient care has become complex, demanding succinct interprofessional
communication and collaboration to optimize the care of the patient, and the nurse at the
bedside is the optimal leader at the point of care. Assistance with the clinical reasoning and
critical thinking with nursing students is pivotal for successful patient outcomes. The expert
clinical nurse at the bedside is the premier faculty to guide the young practitioner in the care of
the patient. A dedicated educational unit (DEU) is an example of an academic–practice
partnership designed to provide students with a positive clinical learning environment. The
purpose of this qualitative research study was to identify the role perceptions of staff nurse's
participating as clinical instructors on a DEU and the perceived educational learning needs of the
experienced staff nurses. After Veterans Affairs Boston Healthcare System Institutional Review
Board approval, a total of 8 nurses serving in the role of clinical instructor on a DEU
participated in the study. Content analyses were used to code and synthesize common theses
from the interviews. The themes that emerged related to role perception were mentoring,
ensuring competency with basic skills and tasks, and development of critical thinking in nursing
clinical education. The themes related to perceived learning needs of staff nurses related to the
role of clinical instructor were the need for clear objectives from the academic affiliate, more
coordination and acknowledgement by the academic affiliate, and addition education in dealing
with students with diverse learning needs and accommodations. (Index words: Dedicated
education unit; Clinical instructors; Academic practice partnerships; Perceived learning needs)
J Prof Nurs 33:108–112, 2017. Published by Elsevier Inc.

O VER THE PAST decade, health care leaders have

called for a radical transformation in health care and
nursing education. The 2010 Institute of Medicine Future
of Nursing Report identified the need for change in
*Assistant Professor of Nursing, Simmons College, Boston, MA.
†Nurse Scientist, Veterans Affairs Boston Healthcare System, Boston, MA.
‡Associate Chief of Nursing and Patient Care Services, VA Boston
Healthcare System.
§Nursing Affiliations Program Director, VA Boston Healthcare System.
║Post Baccalaureate Nurse Residency and Transition to Practice Program
Director, VA Boston Healthcare System.
¶Nursing Affiliations Program Assistant Director, VA Boston Healthcare
System.
#Post Baccalaureate Nurse Residency and Transition to Practice Program
Assistant Director, VA Boston Healthcare System.
Address correspondence to Dr. Glynn: Assistant Professor of
Nursing, Simmons College, Nurse Scientist, VA Boston Healthcare
System. E-mail: donna.glynn@simmons.edu
8755-7223
108
http://dx.doi.org/10.1016/j.profnurs.2016.08.005
nursing practice and nursing education (Institute of
Medicine, 2010). The report acknowledged specific goals
related to an increased number of baccalaureate-prepared
nurses and implementation of nurse residency programs.
In order to achieve these goals, academic and practice
partnerships have been formed. The desired outcomes of
the partnerships are to increase nursing student and
practicing nurse's satisfaction and performance, to
increase research initiatives, and to improve patient
outcomes (Beal et al., 2011). With an increased acuity in
patient care, the traditional “clinical placement model” is
ineffective in preparing the nurse of the future for
practice. Nurse educators are being challenged to develop
new delivery systems of education to meet the goals of the
IOM Report. Nursing education must immerse the
student in the “real life” of the practice of nursing in
order to prepare a proficient nursing workforce (Benner,
Sutphen, Leonard, & Day, 2010).
Journal of Professional Nursing, Vol 33, No. 2 (March/April), 2017: pp 108–112
Published by Elsevier Inc.

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DEU ROLE PERCEPTIONS AND LEARNING NEEDS
Over the past 100 years, the nursing profession has
evolved in response to the dynamic changes of the health
care environment, which include advances in technol-
ogy and diagnostic testing that have resulted in
improved patient outcomes (McClure & Black, 2013).
Patient care has become complex, demanding succinct
interprofessional communication and collaboration to
optimize the care of the patient, and the nurse at the
bedside is the optimal leader at the point of care.
Assistance with the clinical reasoning and critical
thinking with nursing students is pivotal for successful
patient outcomes. The expert clinical nurse at the
bedside is the premier faculty to guide the young
practitioner in the care of the patient.
The preceptor/clinical instructor (CI) role in under-
graduate nursing education is complex and multifaceted.
Undergraduate nursing students identify preceptors/CI as
key to their learning in the clinical setting. However, staff
nurse preceptors often feel unprepared to serve in this
role (McClure & Black, 2013). Clinical educators are
required to connect the classroom knowledge with the
clinical practice requirement and support the students
during both experiential and situated learning on the
nursing units (Benner et al., 2010). New models of
nursing clinical education are necessary to ensure student
success.
A dedicated educational unit (DEU) is an example of
an academic–practice partnership designed to provide
students with a positive clinical learning environment. A
DEU is defined as an “optimal teaching/learning envi-
ronment through the collaborative efforts of nurses,
management and faculty” (Moscato, Miller, Logsdon,
Weinberg, & Chorpenning, 2007). The goal is to
maximize the learning outcomes not only of students
but also of practicing clinical nurses in the role of nurse
educator (Moscato et al., 2007).
In the DEU model, an expert nurse (staff nurse) is
responsible for the clinical education of two nursing
students. The expert nurse, referred to as a CI, provides
instruction related to clinical skills and critical thinking
to the nursing students in an integrated job-embedded
manner (Nishioka, Coe, Hanita, & Moscato, 2014). The
expert nurse is defined as “competent” according to
Benner (1982, pg 404). The competent nurse has 2 to 3
years of nursing expertise, is Bachelor of Science in
Nursing prepared, and demonstrates “mastery and the
ability to cope and manage many contingencies of clinical
nursing” (Benner, 1982, pg 405). The CI is informed of
the course curriculum, and the onsite academic faculty
serves as a coach to help the CIs grow in the role of nurse
educator.
The nursing student's successful outcomes in the DEU
model have been well documented (Edgecombe &
Bowden, 2013; Moore & Nahigian, 2013; Mulready-
Shick & Flanagan, 2014). However, little research has
been completed evaluating the CIs perceptions of the role
and perceived learning needs. The purpose of this
research study was to identify the role perceptions of
staff nurse's participating as CIs on a DEU and the
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109
perceived educational learning needs of the experienced
staff nurses.
Background
The DEU model was first developed by the Flinders
University of South Australian School of Nursing in the
late 1990s. The model was reproduced by the University
of Portland School Of Nursing in 2003. The goals of the
program was to “improve nursing education, increase
effectiveness of nursing resources, and increase the
number of nursing graduates” prepared to enter the
health care arena (Moscato, Nishioka & Coe, 2013,
pg. 259). This model is a shift in nursing clinical
education. The DEU model has the expert practicing
clinical nurses employed by the health care organization
educating the student nurses in a 2 student to 1 expert
nurse ratio. The expert practicing clinical nurse, known
as CI, is responsible for the learning experience including
ongoing evaluating related to performance and learning
outcomes. The goal of the students is to gain the
necessary knowledge, skills, and attitudes to practice in
the health care system. The DEU model merges faculty
and clinical nurses to maximize the clinical skills of
practicing nurses with the teaching expertise of faculty.
The onsite academic faculty serves as a coach to provide
clinical supervision, mentoring, and support on the units
(Nishioka et al., 2014). The onsite academic faculty is
responsible for overseeing any interpersonal, evaluation,
or disciplinary issues that may arise.
In the Portland DEU model, the CIs participate in
an orientation workshop to familiarize the clinical
nurses with the mission, philosophy, and curriculum
of the school of nursing. The CIs are provided
information on clinical instruction, evaluation, clinical
reasoning, and course specifics. The program is devel-
oped by the academic affiliate, and the CIs receive faculty
handbooks, syllabi, clinical expectations, evaluation
forms, and contact information (Kaakinen, 2005;
Moscato et al., 2007).
The outcomes of the DEU model are a stronger
academic–practice partnership and a more prepared
graduate nurse to enter professional practice. Compared
with the traditional clinical educational settings, the
literature reports that the DEU model provides a better
clinical experience for students and allow for the
professional development of nurses involved in clinical
education (Nishioka et al., 2014).
As the outcomes of the DEU model supports an
improved clinical educational outcome for the student
nurse, little research has been completed to evaluate the
role perceptions of the CIs and the perceived learning
needs of the expert staff nurses serving in this role.
Because the goals of academic–practice partnerships and
a DEU must be mutual (Beal et al., 2011), a need to
evaluate the expert nurses learning needs related to the
role of CI is important to prepare future clinical and
academic instructors.
110
The DEU is a pioneering model of new collaboration
between academe and practice that evolved—and con-
tinues to evolve—in turbulent economic and volatile
times. Unpacking the dynamics involved in creating and
sustaining this collaborative partnership points the way for
new thinking required at a critical juncture for the U.S.
health care system (Warner & Burton, 2009). Letting go of
the old ways is essential for success. Trust must be
established between practice and academia partners. With
the emergence of new models and collaborations, mutually
measurable established goals and outcomes may be
obtained (Warner & Burton, 2009).
The DEU model began at the Veterans Affairs (VA)
Boston Healthcare System in 2011. Bachelor of Science in
Nursing-prepared nurses were invited to participate in
the role of CI. The nurses who agreed to participate had a
minimum of 5 years of nursing experience within the VA
Boston, and several had obtained their MSN. Initially, the
nurses were educated regarding the goals and objectives
of the DEU model, staffing, grading, and the student
evaluation process. No formal orientation to the role
occurred. Currently, there are three schools of nursing
with active DEU experiences for 2nd year, 3rd year, and
senior nursing students at the facility.
Methods
The purpose of this qualitative study was to identify the
role perceptions of clinical nurses participating as CIs on
a DEU and the perceived educational learning needs of
the clinical nurses. The study took place at the VA Boston
Healthcare System. The VA Boston has a unique
academic–practice partnership that includes six colleges
of nursing. After VA Boston Institutional Review Board
approval, a total of 14 staff nurses serving in the role of CI
were asked to participate in the interview process. The
nurses who agreed to participate represented two of the
colleges of nursing DEU projects. Interview questions
were developed by the researchers in an attempt to
capture the perceived role perceptions of staff nurses
participating as CIs on a DEU and the perceived
educational learning needs of the staff nurses. The
interview questions asked the participants to describe
the CIs' perceptions of the role, preparation for the role,
perceived support from the academic affiliate, identifica-
tion of additional learning/support to enhance the role of
CI, and their willingness to participate in the DEU in the
future. Participation in the study was voluntary and the
CIs remained anonymous. All CIs were invited to
participate regardless of the academic affiliation on the
DEU. Of the 14 nurses who have worked in the role of CI
on a DEU, a total of 8 nurses agreed to participate in the
study. The audiotapes were transcribed verbatim. All
researchers were involved in the data analysis. Content
analyses were used to code and synthesize common
themes from the interviews.
Results
A total of three themes emerged in regard to the staff
nurses' perceptions of the role of the CI on the DEU, and
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GLYNN ET AL
several themes emerged in conjunction with the per-
ceived learning needs of the staff nurses functioning in
the role of CI. An additional theme, not related to the
research question, was identified related to the need for
support from both practice and academic nursing
leadership for the success of the DEU.
The three themes that emerged regarding the percep-
tions of the role of CI by participating staff nurses on a
DEU were mentoring, ensuring competency with basic
skills and tasks, and the critical thinking component of
nursing education.
Mentoring
The staff nurses overwhelmingly identified the role of CI
as a mentor, not as an educator. The staff nurses reported
that CIs were functioning as a role model for the students
and that the role was “more than a preceptor.” One nurse
stated, “I did not feel supported during my clinical
rotations as a nursing student. Now I always think that I
am working with my students and I feel that I am
supposed to be there as their mentor and ensure the best
experience.” Another added, “I am a role model as they
do look up to me and look at me as the experienced
person.” A clinical instructor reported that “my role is
basically a role model. I will try to give them as much
experience and advice as I can.” Regarding comparisons
to the precepting role, a CI reported, “I feel that I have
more responsibilities. I am responsible for the paperwork
and the evaluation. I feel that I need to ensure that the
student is meeting course objectives.”
Ensuring Competency With Basic Skills and Tasks
The CIs reported the importance in their role to ensure
that the basic nursing skills and tasks had been mastered
and that the role needed to guarantee a solid foundation
in nursing. A CI reported, “We want the students to get
the basics down.” Another added, “Students need to have
a strong foundation in nursing and need to go back to the
basics. I feel that as a clinical instructor I need to be sure
that all of the students are doing the basics and the
foundations correctly. I need to teach the students the
fundamentals and were to look things up and how to do
things the rights way. I am here to show them the correct
way to provide the best care to our veterans.” A CI stated,
“My role was to investigate what knowledge the student
had to begin with and then build up from there. Any
weaknesses that might be missing and improve their
nursing skills. From obtaining blood pressure to
assessment to any more involved skills like changing a
Foley to wound care.” Another added, “I am providing
the basic education for the new nurses. So I think that my
role is to continue educating and going over the basic
skills with new nurses.”
Begin the Critical Thinking
Component of Nursing Education
The CIs viewed their role as an important concept in the
development of critical thinking skills. A nurse stated,
“Nursing involves more critical thinking and my role of
DEU ROLE PERCEPTIONS AND LEARNING NEEDS
clinical instructor allows me to work with the students to
put those puzzle pieces together and develop crucial
thinking skills. I work with the student to advance their
assessment skills and apply their classroom knowledge to
the patient situation.” Another added, “…it is a challenge
to teach the students how to gather all of the necessary
information on their patients. To make sure they know
what the medications are and what they are being given
for and they need to do all of that before they go into meet
the patient. Students need to learn how to get the full
picture of the patient before they jump into the care of the
patient.”
Three themes emerged related to the perceived
learning needs of staff nurses participating in the role of
CI on a DEU. The themes are clear objectives from the
academic affiliate, more coordination and acknowledge-
ment by the academic affiliate of the CI role, and
additional education in dealing with students with
diverse learning needs and accommodations.
Clear Objectives From the Academic Affiliate
The nurses identified that a structured curriculum would
be helpful to ensure that objectives were met. A CI stated,
“I feel that if you don't have clear objectives as to what
needs to be obtained in a certain timeframe, we cannot
truly assess student clinical learning. Benchmarks are
important. With time to remediate. To be consistent, the
clinical instructors on our unit developed goals for our
students on a weekly basis.” Another added, “knowing
what they were doing in school and mirroring it here.”
Another CI concurred, “More course coordination. If
they are studying heart failure, let me know because I
have patients who have heart failure and I can add to their
book knowledge with the clinical experience.” In
addition, “If we had a structured curriculum or objectives
to follow it would help. The structure would allow us to
go week by week to assure that the students are observing
in clinical the information that they are learning in the
classroom environment.”
Acknowledgment by the
Academic Affiliate of the CI Role
The CIs overwhelmingly reported a sense of commitment
by the academic institution, and the presence of an
academic faculty on the unit was appreciated. However,
the CIs desired more recognition from the academic partner
regarding their role. A nurse stated, “I would love to receive
timely feedback from the previous semester and therefore
could grow from that feedback.” A nurse reflected on the
role of the academic affiliate nurse and stated, “I feel that the
academic affiliate nurse is there to support the students
more than the instructors.” Several nurses discussed the
desire to receive an adjunct appointment for their
participation on the DEU in the role of CI.
Learning Needs Related to Students With
Diverse Learning Needs and Accommodations
The staff nurses in the role of CI identified learning needs
related to students with learning accommodations and
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111
dealing with students with language barriers. A nurse
reported, “I asked the girl to write a SOAP note and it was
scattered and I was confused. She could never get her
focus to write a clear note. She stated that she had a
learning accommodation, but I did not have the
background to work with her.” Language skills and
barriers were identified as a learning need by the CIs. A
student with English as a second language was caring for
a patient, “…the patient was visibly upset that his student
nurse did not have English as her primary language. The
patient was disrespectful to the student. That is very
challenging. I would be very cautious. I did not want to
hurt anyone's feelings. Many times I would jump in to
protect the students from the situation.”
An additional theme related to the commitment by all
partners to work together was identified during the
interviews. The CIs reported the need for a staffing
commitment on the units to support the learning needs of
the students and the staff nurses. One nurse stated, “I
have always had the support of my nurse manager, but
that was not the case on all units. Some managers do not
fully understand that the unit is dedicated to nursing
education and the managers need to ensure that the
staffing is what it needs to be to support the goals.” The
CIs reported a feeling of disconnect with the academic
partners. A nurse stated, “I would like to have meetings
with the academic faculty. The students would see more a
supportive team. The students could see the full circle
approach to the education.” Another added, “I do feel
that the academic affiliate nurse is there to support the
students more than the clinical instructors.” The CIs
reported that more work needed to be done with the
relationship between the academic and practice partner-
ship and the staff nurses working in the role of CI.
Discussions
The DEU model represents an important collaboration
between academic and practice partnerships. The
restructuring of traditional nursing clinical education
will allow for the nursing students to participate in
high-quality care and be valued on the patient care unit.
The expert staff nurses are allowed to expand their
expertise and develop effective teaching skills. The
traditional clinical faculty role is transformed to a
position of coaching and support for the CIs. These
efforts will have an important impact on nursing
clinical education and the potential to reduce the clinical
faculty shortage.
The results of this study identify the role perceptions of
the staff nurses functioning in the role of CI. The role of
mentor, educator, and advisor was apparent in the
research. The acquisition of the necessary nursing basic
skills is a critical step to the development of critical
thinking and clinical judgment. The research supports
Benner et al. position (2010) on the need for experiential
learning and situated learning at the clinical site.
The CIs did report that they would benefit from a
structured orientation to the role and the development of
clear clinical objectives from the academic affiliate. The
112
nurses' stated that increased communication with the
academic affiliate to merge theory and practice would be
of great benefit to the nursing students. The CIs asked for
increased education when dealing with students with
learning accommodations. These recommendations were
reviewed and are in development with the VA Boston
Healthcare System and will be implemented.
The practice partners in the DEU agreement need to
ensure that a commitment to provide the necessary
staffing to support the role of the CIs is consistent. Staff
nurses are faced with increased patient acuity, shortened
length of stay, and increased demands to provide quality
patient care. The VA utilizes a staffing methodology
system as a method of determining appropriate direct
care staffing for VA nursing personnel. This process takes
into account analysis of multiple variables to recommend
safe and effective staffing levels at various points of care.
The DEU model has been incorporated into the staffing
methodology. When the VA Boston committed to
supporting the DEU model, it was with the understand-
ing that staff serving in the role of CI would be accounted
for in the calculation as their patient caseload would be
less. This requires the support of both upper management
and the nurse managers to be effective. Because of the
positive outcomes for both CIs and student nurses, it was
agreed that the necessary resources to support the DEUs
will be ongoing.
Conclusions
Current practices in CI and preceptor preparation must
continue to be examined to ensure that processes
adequately meet the CI's needs. Because of constant and
dynamic changes in our current health care systems,
academic faculty, clinical staff, clinical staff leadership,
clinical staff faculty, and students must engage in an
interactive teaching and learning process to ensure that
future generations of nurses are meeting the learning
objectives and goals needed to be a successful nursing
professional.
Academic–Practice partnerships must demonstrate a
commitment to provide the infrastructure necessary to
support the nursing students and the staff nurses serving
in the role of CI. American Association of Colleges of
Nursing recognizes that academic–practice partnerships
are an excellent forum to bring both partners to the table
and provide involvement of the selections of nursing
student and CIs on the nursing care units. As the role of
CI continues to expand, further research evaluating the
development of clinical judgment and reasoning in
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GLYNN ET AL
nursing students needs to be measured in the DEU
model. Expanding the DEU model to Senior Capstone
experiences needs to be assessed as a successful method
of senior nursing student education. The perceptions of
the staff nurses' functioning in the role of CIs are positive
and demonstrate career growth and movement to the
proficient level of performance.
References
Beal, J., Breslin, E., Austin, T., Brower, L., Bullard, K., Light, K.,
& Ray, N. (2011). Hallmarks of best practices in academic-service
partnerships in nursing; Lessons learned from San Antonio.
Journal of Professional Nursing, 27, 90–95.
Benner, P. (1982). From novice to expert. American Journal of
Nursing, 402–440.
Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010).
Educating nurses: a call for radical transformation. San Francisco:
Jossey-BassC2010.
Edgecombe, K., & Bowden, M. (2013). Clinical learning and
teaching innovations in nursing: dedicated education units building
a better future. New York, NY: Springer.
Institute of Medicine (2010). http://iom.nationalacademies.
org/Reports/2010/The-Future-of-Nursing-Leading-Change-
Advancing-Health.aspx#sthash.l3WGOg5R.
Kaakinen, J. (2005). Clinical teaching handbook for faculty
instructors. Portland, OR: University of Portland.
McClure, E., & Black, L. (2013). The role of the clinical
preceptor: An integrative literature review. Journal of Nursing
Education, 52, 335–341.
Moore, J., & Nahigian, E. (2013). Nursing student percep-
tions of nurse-to-nurse collaboration in dedicated education
units and in traditional clinical instruction units. Journal of
Nursing Education, 2, 346–350.
Moscato, S., Miller, J., Logsdon, K., Weinberg, S., &
Chorpenning, L. (2007). Dedicated education unit: An innova-
tive clinical partner educational model. Nursing Outlook, 55,
31–37.
Moscato, S., Nishioka, V., & Coe, M. (2013). Dedicated
education unit: Implementing an innovation in replication sites.
Journal of Nursing Education, 52, 259–267.
Mulready-Shick, J., & Flanagan, K. (2014). Building
the evidence for dedicated education unit sustainability
and partnership success. Nursing Education Perspectives, 5,
287.
Nishioka, V., Coe, M., Hanita, M., & Moscato, S. (2014).
Dedicated education unit: Nurse perspectives on their
clinical teaching role. Nursing Education Perspectives, 5,
294–300.
Warner, J., & Burton, D. (2009). The policy and politics of
emerging academic-service partnerships. Journal of Professional
Nursing, 25, 329–334.